Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $89.13 / $269.15 / $954.99	Facility		$89.13	$269.15	$954.99
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $12.88 / $12.88 / $83.18	Facility	26	$12.88	$12.88	$83.18
Aetna Facility/Professional Professional Modifier Low / Median / High Price $79.43 / $104.71 / $457.09	Professional		$79.43	$104.71	$457.09
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.88 / $19.95 / $85.11	Professional	26	$12.88	$19.95	$85.11
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $67.61 / $81.28 / $194.98	Professional	TC	$67.61	$81.28	$194.98
Cigna Facility/Professional Facility Modifier Low / Median / High Price $275.42 / $281.84 / $288.40	Facility		$275.42	$281.84	$288.40
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $48.98 / $50.12 / $52.48	Facility	26	$48.98	$50.12	$52.48
Cigna Facility/Professional Professional Modifier Low / Median / High Price $102.33 / $245.47 / $309.03	Professional		$102.33	$245.47	$309.03
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.50 / $35.48 / $44.67	Professional	26	$19.50	$35.48	$44.67
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $79.43 / $208.93 / $263.03	Professional	TC	$79.43	$208.93	$263.03
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $91.20 / $134.90 / $346.74	Professional		$91.20	$134.90	$346.74
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $14.45 / $24.55 / $57.54	Professional	26	$14.45	$24.55	$57.54
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $75.86 / $112.20 / $302.00	Professional	TC	$75.86	$112.20	$302.00
Medica Facility/Professional Facility Modifier Low / Median / High Price $112.20 / $218.78 / $602.56	Facility		$112.20	$218.78	$602.56
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $50.12 / $100.00 / $100.00	Facility	26	$50.12	$100.00	$100.00
Medica Facility/Professional Professional Modifier Low / Median / High Price $89.13 / $154.88 / $691.83	Professional		$89.13	$154.88	$691.83
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $16.60 / $23.44 / $151.36	Professional	26	$16.60	$23.44	$151.36
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $69.18 / $100.00 / $588.84	Professional	TC	$69.18	$100.00	$588.84
Midlands Facility/Professional Professional Modifier Low / Median / High Price $169.82 / $204.17 / $263.03	Professional		$169.82	$204.17	$263.03
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $31.62 / $34.67 / $41.69	Professional	26	$31.62	$34.67	$41.69
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $134.90 / $169.82 / $223.87	Professional	TC	$134.90	$169.82	$223.87
Midlands Facility/Professional Facility Modifier Low / Median / High Price $288.40 / $288.40 / $288.40	Facility		$288.40	$288.40	$288.40
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $52.48 / $52.48 / $52.48	Facility	26	$52.48	$52.48	$52.48
Midlands Facility/Professional Professional Modifier Low / Median / High Price $158.49 / $169.82 / $263.03	Professional		$158.49	$169.82	$263.03
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $30.90 / $36.31 / $50.12	Professional	26	$30.90	$36.31	$50.12
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $125.89 / $141.25 / $223.87	Professional	TC	$125.89	$141.25	$223.87
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $16.60 / $97.72 / $194.98	Professional		$16.60	$97.72	$194.98
United Facility/Professional Facility Modifier Low / Median / High Price $316.23 / $549.54 / $741.31	Facility		$316.23	$549.54	$741.31
United Facility/Professional Professional Modifier Low / Median / High Price $85.11 / $109.65 / $208.93	Professional		$85.11	$109.65	$208.93
United Facility/Professional Professional Modifier 26 Low / Median / High Price $15.85 / $19.95 / $37.15	Professional	26	$15.85	$19.95	$37.15
United Facility/Professional Professional Modifier TC Low / Median / High Price $70.79 / $91.20 / $177.83	Professional	TC	$70.79	$91.20	$177.83
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $173.78 / $173.78 / $204.17	Professional		$173.78	$173.78	$204.17
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $26.30 / $26.30 / $30.90	Professional	26	$26.30	$26.30	$30.90
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $147.91 / $147.91 / $173.78	Professional	TC	$147.91	$147.91	$173.78